OBJECTIVES:  To assess the economic burden from vision loss on the health care system in Taiwan.   METHODS: This is a retrospective matched cohort study, with study population retrieved from the National Health Insurance Research Database between 01/01/2000 and 12/31/2008. Based on the ICD-9-CM codes, cases initially diagnosed with moderate vision loss (369.6-369.9), severe vision loss (369.1-369.4), or blindness (369.0-369.08) were identified. Each case was matched to a randomly selected control with normal vision by age (± 1 year) and gender. Each control was assigned the same index date, the initial diagnosis date of vision loss, as the corresponding case. For each pair, the annual medical costs were calculated during the one year after index date. All medical costs were adjusted to 2010 New Taiwan dollars (NT$, US$1 ≈ NT$30). A generalized linear model with gamma distribution and log-link was used to estimate the differences in post-index annual increased costs while adjusting for baseline characteristics and pre-index logged costs. Bootstrapping technique was used to generate 95% confidence interval (CI).   RESULTS: A total of 2,233, 283, and 350 patients with moderate vision loss, severe vision loss, and blindness were identified, respectively. Patients with moderate vision loss, severe vision loss, and blindness had NT$13,888 (CI 8,564-19,236), NT$23,768 (CI 7,764-42,379) and NT$75,461 (CI 56,123-94,685) higher annual medical costs as compared with their matched controls. Inpatient services (62.3%) constituted the largest component of total medical costs for blindness, followed by outpatient services (26.8%) and emergence care (4.3%). Similar patterns were observed for moderate and severe vision loss.   CONCLUSIONS: Consistent with the Western world, significantly higher medical costs are associated with vision loss in Taiwan. The additional costs seem to be related to the extent of the vision loss, with blindness incurring the highest costs, followed by severe vision loss and then moderate vision loss.